OBJECTIVE Analysis of the effects of pharmacological stress echocardiography using dobutamine on left ventricular function in patients with and without evidence of coronary heart disease. METHODS During dobutamine stress echocardiography, aortic flow and transmitral velocities, left ventricular end-diastolic and end-systolic diameters, wall thickness and fractional shortening were determined in 124 patients. RESULTS 36% of the patients showed a pathological wall motion response during echo, which indicates relevant coronary artery disease (group II). After dobutamine stress these patients had significantly lower peak (1.71 m/s) and mean (1.29 m/s) aortic outflow tract velocities compared to patients with normal stress echo (group I; 64%; 2.24 res. 1.67 m/s). Peak transmitral diastolic filling velocity increased significantly less among patients with abnormal stress echo compared to those with normal stress echo. E/A-relation remained unchanged. In addition there was a significantly decrease of the left ventricular end-diastolic and end-systolic diameter and of the fractional shortening in group I compared to group II. CONCLUSIONS Dobutamine stress testing leads to different haemodynamic and left ventricular changes in patients with and without coronary heart disease. The frequency of false negative and false positive stress echocardiographies may be reduced especially by evaluating aortic Doppler parameters, left ventricular diameters and fractional shortening.